Reimbursement Coordinator II

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Confirm patient insurance benefits, coverage eligibility, and requirements for prior authorization.

• Initiate, submit, and monitor prior authorization requests with Medicare, Medicaid, and commercial payers.

• Organize the collection and evaluation of clinical documentation, medical records, coding details, and necessary forms.

• Track authorization status and follow up with provider offices and payers to ensure timely coverage decisions.

• Assess authorization denials and assist with reconsideration, resubmission, and appeal efforts.

• Interpret payer coverage policies, reimbursement standards, and authorization guidelines.

• Collaborate with field staff and healthcare provider offices to offer insights on authorization processes, reimbursement options, and payer requirements.

• Keep precise case records, reporting data, and reimbursement materials up to date.

• Assist in operational audits, productivity tracking, and process enhancements.

• Work collaboratively in a virtual setting with provider offices, field-based partners, payer representatives, and internal stakeholders.

⛳️ Requirements

• High School Diploma with at least 2 years of experience in prior authorization, reimbursement, healthcare revenue cycle, payer operations, insurance verification, or patient access support.

• Familiarity with Medicare, Medicaid, and commercial payer authorization procedures.

• Experience in reviewing and coordinating medical documentation for prior authorization submissions.

• Proficient in Microsoft Excel and case management, customer relationship management (CRM), or healthcare workflow systems.

• Ability to manage multiple cases concurrently while adhering to quality and turnaround standards.

• Unrestricted U.S. work authorization at the time of hire and throughout employment.

• Preferred: Associate's or Bachelor's degree.

• Preferred: AAPC Coding Certification.

• Preferred: Experience in supporting medical device, neuromodulation, or healthcare reimbursement programs.

• Preferred: Knowledge of ICD-10 and CPT coding.

• Preferred: Experience with Salesforce and healthcare reimbursement or patient access platforms.

• For degrees obtained outside the United States, a qualification meeting 8 C.F.R. § 214.2(h)(4)(iii)(A) is required.

🏝️ Benefits

• Competitive salary and a flexible benefits package.

• Health insurance.

• Dental insurance.

• Vision insurance.

• Health Savings Account.

• Healthcare Flexible Spending Account.

• Life insurance.

• Long-term disability leave.

• Dependent daycare spending account.

• Tuition assistance/reimbursement.

• Simple Steps global well-being program.

• Incentive plans.

• 401(k) plan with employer contribution and matching.

• Short-term disability.

• Paid time off.

• Paid holidays.

• Employee Stock Purchase Plan.

• Employee Assistance Program.

• Non-qualified Retirement Plan Supplement.

• Capital Accumulation Plan for eligible employees.

• Paid sick time for temporary employees as mandated by applicable state law.